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ACCIDENT PREVENTION AND LIFE SAVING
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Annotations ACCIDENT PREVENTION AND LIFE SAVING
THE old excuse that accidents will happen can never again be worth making. The working party set up by the Royal College of Surgeons to study this modern epidemic concludes, in its final report,l that the only unpreventable accidents are those caused by unpredictable natural forces; and they are rare. The others could-theoretically, at least-be eliminated. After more than a year’s inquiry, culminating in a public convention2 on accident prevention and life saving, the working party has some suggestions as to how this end might one day be achieved. Preventive measures, says its report, must take account of both the behavioural and the environmental factors that contribute to every accident. The habit of safety ought to be inculcated from childhood. Certainly, children need protection; but they must be taught the proper and careful use of dangerous equipment, and not merely kept out of harm’s way. They should be introduced early to the more adventurous adult pastimes, such as sailing and climbing, and thoroughly instructed therein; thus, by the time they are adolescent and given to showing off, they will also be reasonably skilled and experienced. There is the same need for the preliminary training of young people entering industry: the skilled way of working is always the safe way, and the industrial accident-rate is highest among workers under 25 years of age whose experience is shortest. But above all, since youth is more susceptible to example than to precept, there is need for a general educative campaign, backed by press and radio, to arouse adult interest in accident prevention and to overcome public complacency in the face of unnecessary death. Next in importance to prevention, says the report, is the ability to cope with an accident when it occurs and with the injury it may inflict. This ability should be very much more widespread than it is. Every child, from the age of 9 or 10, should be trained in the techniques of first-aid and resuscitation. Many of our young men and women would be glad to undertake to provide preventive and rescue services such as the surf life-saving clubs already established in the West Country: they should be given more opportunity of doing so. Few doctors take the constructive interest in first-aid that they should, and, as a result, the methods recommended and employed are not kept abreast of advances in medical research. Few doctors, indeed, are adequately trained themselves to teach or advise firstaid workers. All medical students should be fully instructed in the principles and practice of first-aid, and general practitioners should receive further postgraduate training besides. If the medical profession were better informed itself it would be in a better position to persuade the rest of the community to take their accidents seriously. Many of its members, however, partake of the general apathy: they fail, for instance, to draw their patients’ attention to danger-points in their homes, and they prescribe too generously without always emphasising that the drugs could be dangerous. The report suggests that the profession should bestir itself and take a lead in the fight against accidents of all kinds. It recommends that a permanent commission of medical men should be set up as a source of expert opinion on accident prevention and life saving. The study of 1. 2.
Working Party on Accident Prevention and Life Saving. Royal College of Surgeons of England. London, 1963. Pp. 74. 5s. See Lancet, May 25, 1963, p. 1147.
accidents and analysis of contributing causes must continue, since of these enough can never be known. But knowledge, once gained must be applied, and this the commission could help to ensure. LUNG CANCER AND MONTH OF BIRTH
A NEW,and possibly important, observation has been made in Holland concerning the early background of patients with cancer of the bronchus. Dijkstraobserved among 330 cases from the northern part of the country
diagnosed by biopsy, cytology, operative procedure, or necropsy, with survivors followed up so that incorrectly diagnosed cases were discarded, that the numbers of cases varied from year to year. For example, few of those born in 1888, 1895, 1899, and 1902, but 1893, 1897, 1898, and 1900. This prompted study of the season of birth, and it soon appeared that affected
were
many in
bronchial cancer is much more likely to develop in those born in winter than in those born in summer. Persons born in March were twice as susceptible to carcinoma of the bronchus as those born in the summer months. Dijkstra brings forward an ingenious hypothesis to explain this observation. He points out that at birth not all the branches of the bronchial tree are formed but only those in a zone around the hilum. When the lungs begin to function, the peripheral ramifications grow and acquire their epithelial lining from the point of new branchingthat is, at the end of the last newly growing ramus. Thus is the middle zone of the lung formed, and it is in this zone, in the medium-sized bronchi, that carcinoma so often arises. Dijkstra states that the outer zone is formed in youth. Thus in the mid-lung at birth there is actively growing bronchial epithelium, which is supposed to be more vulnerable to damage than that of the inner zone. How can this tissue be damaged by seasonal influences in such a way that carcinoma ensues ? It has been shown that metaplasia of the bronchial epithelium is a characteristic lesion of vitamin-A deficiency in animals and children.2 Metaplasia of the ciliated bronchial epithelium to a pavement type has been described as preceding the development of carcinoma; and Dijkstra postulates that the newborn child, unable to store carotene and having depleted its store of liver vitamin A during the second half of foetal life, relies for a supply of vitamin A on mother’s or cow’s milk, the former being richer in the vitamin. At the end of the winter both human and cow’s milk are seriously depleted of the vitamin. Dijkstra regards this lack of vitamin A as an important factor in carcinogenesis, causing damage (i.e., metaplasia) at the moment of growth and differentiation of the mid-zone bronchial
epithelium. In this country, during and since the 1939-45 war, very many babies have been fed on dried milk. An investigation of its vitamin-A content would be interesting, but it will be many years before it can be ascertained whether
milk containing an adequate supply of vitamin A will prevent the development of carcinoma of the bronchus in later life. Lawrence and Bern3 found that local application of vitamin A to the hamster cheek pouch caused mucous metaplasia of the keratinising squamous epithelium lining the pouch, and similar metaplasia was observed by Fell4 in embryonic chick epidermis. Thus 1. 2. 3. 4.
Dijkstra, B. K. S. J. nat. Cancer Inst. 1963, 31, 511. Bohrod, M. G. in Progress in Allergy (edited by P. Kallos); p. 31. Basle, 1954. Lawrence, D. J., Bern, H. A. Exp. Cell Res. 1960, 21, 443. Fell, H. B. Proc. Roy. Soc. B. 1957, 146, 242.
Annotations ACCIDENT PREVENTION AND LIFE SAVING
THE old excuse that accidents will happen can never again be worth making. The working party set up by the Royal College of Surgeons to study this modern epidemic concludes, in its final report,l that the only unpreventable accidents are those caused by unpredictable natural forces; and they are rare. The others could-theoretically, at least-be eliminated. After more than a year’s inquiry, culminating in a public convention2 on accident prevention and life saving, the working party has some suggestions as to how this end might one day be achieved. Preventive measures, says its report, must take account of both the behavioural and the environmental factors that contribute to every accident. The habit of safety ought to be inculcated from childhood. Certainly, children need protection; but they must be taught the proper and careful use of dangerous equipment, and not merely kept out of harm’s way. They should be introduced early to the more adventurous adult pastimes, such as sailing and climbing, and thoroughly instructed therein; thus, by the time they are adolescent and given to showing off, they will also be reasonably skilled and experienced. There is the same need for the preliminary training of young people entering industry: the skilled way of working is always the safe way, and the industrial accident-rate is highest among workers under 25 years of age whose experience is shortest. But above all, since youth is more susceptible to example than to precept, there is need for a general educative campaign, backed by press and radio, to arouse adult interest in accident prevention and to overcome public complacency in the face of unnecessary death. Next in importance to prevention, says the report, is the ability to cope with an accident when it occurs and with the injury it may inflict. This ability should be very much more widespread than it is. Every child, from the age of 9 or 10, should be trained in the techniques of first-aid and resuscitation. Many of our young men and women would be glad to undertake to provide preventive and rescue services such as the surf life-saving clubs already established in the West Country: they should be given more opportunity of doing so. Few doctors take the constructive interest in first-aid that they should, and, as a result, the methods recommended and employed are not kept abreast of advances in medical research. Few doctors, indeed, are adequately trained themselves to teach or advise firstaid workers. All medical students should be fully instructed in the principles and practice of first-aid, and general practitioners should receive further postgraduate training besides. If the medical profession were better informed itself it would be in a better position to persuade the rest of the community to take their accidents seriously. Many of its members, however, partake of the general apathy: they fail, for instance, to draw their patients’ attention to danger-points in their homes, and they prescribe too generously without always emphasising that the drugs could be dangerous. The report suggests that the profession should bestir itself and take a lead in the fight against accidents of all kinds. It recommends that a permanent commission of medical men should be set up as a source of expert opinion on accident prevention and life saving. The study of 1. 2.
Working Party on Accident Prevention and Life Saving. Royal College of Surgeons of England. London, 1963. Pp. 74. 5s. See Lancet, May 25, 1963, p. 1147.
accidents and analysis of contributing causes must continue, since of these enough can never be known. But knowledge, once gained must be applied, and this the commission could help to ensure. LUNG CANCER AND MONTH OF BIRTH
A NEW,and possibly important, observation has been made in Holland concerning the early background of patients with cancer of the bronchus. Dijkstraobserved among 330 cases from the northern part of the country
diagnosed by biopsy, cytology, operative procedure, or necropsy, with survivors followed up so that incorrectly diagnosed cases were discarded, that the numbers of cases varied from year to year. For example, few of those born in 1888, 1895, 1899, and 1902, but 1893, 1897, 1898, and 1900. This prompted study of the season of birth, and it soon appeared that affected
were
many in
bronchial cancer is much more likely to develop in those born in winter than in those born in summer. Persons born in March were twice as susceptible to carcinoma of the bronchus as those born in the summer months. Dijkstra brings forward an ingenious hypothesis to explain this observation. He points out that at birth not all the branches of the bronchial tree are formed but only those in a zone around the hilum. When the lungs begin to function, the peripheral ramifications grow and acquire their epithelial lining from the point of new branchingthat is, at the end of the last newly growing ramus. Thus is the middle zone of the lung formed, and it is in this zone, in the medium-sized bronchi, that carcinoma so often arises. Dijkstra states that the outer zone is formed in youth. Thus in the mid-lung at birth there is actively growing bronchial epithelium, which is supposed to be more vulnerable to damage than that of the inner zone. How can this tissue be damaged by seasonal influences in such a way that carcinoma ensues ? It has been shown that metaplasia of the bronchial epithelium is a characteristic lesion of vitamin-A deficiency in animals and children.2 Metaplasia of the ciliated bronchial epithelium to a pavement type has been described as preceding the development of carcinoma; and Dijkstra postulates that the newborn child, unable to store carotene and having depleted its store of liver vitamin A during the second half of foetal life, relies for a supply of vitamin A on mother’s or cow’s milk, the former being richer in the vitamin. At the end of the winter both human and cow’s milk are seriously depleted of the vitamin. Dijkstra regards this lack of vitamin A as an important factor in carcinogenesis, causing damage (i.e., metaplasia) at the moment of growth and differentiation of the mid-zone bronchial
epithelium. In this country, during and since the 1939-45 war, very many babies have been fed on dried milk. An investigation of its vitamin-A content would be interesting, but it will be many years before it can be ascertained whether
milk containing an adequate supply of vitamin A will prevent the development of carcinoma of the bronchus in later life. Lawrence and Bern3 found that local application of vitamin A to the hamster cheek pouch caused mucous metaplasia of the keratinising squamous epithelium lining the pouch, and similar metaplasia was observed by Fell4 in embryonic chick epidermis. Thus 1. 2. 3. 4.
Dijkstra, B. K. S. J. nat. Cancer Inst. 1963, 31, 511. Bohrod, M. G. in Progress in Allergy (edited by P. Kallos); p. 31. Basle, 1954. Lawrence, D. J., Bern, H. A. Exp. Cell Res. 1960, 21, 443. Fell, H. B. Proc. Roy. Soc. B. 1957, 146, 242.